MeST Seminar with Astrid Fly Oredsson (Århus)

Psychiatric Taxonomy and Epistemic Injustice: The case of borderline personality disorder, inappropriate anger and moral agency.

While “inappropriate” anger is one of nine diagnostic criteria for borderline personality disorder (BPD) in the DSM-5, it is vaguely defined relying on imprecise terminology such as temper, enduring bitterness and verbal outbursts as illustrative examples thus leading to uncertainty about its clinical application. This heightens risk of a kind of BPD-related epistemic injustice within psychiatry. In particular, it could result in all or most anger expressed by people with a BPD diagnosis being characterized by practitioners as inappropriate and pathological even in cases where the anger in question can reasonably be considered appropriate.

This qualifies as epistemic injustice, more specifically, as testimonial and hermeneutical injustice. First, it could result in the credibility of patients’ anger testimonies being unduly undermined as a result of prejudices about the BPD diagnosis. Second, it limits the meanings available to those with the diagnosis, limiting their ability to express anger without significant risk of this being misconstrued and interpreted as pathological.

Furthermore, if we conceive of anger as a reaction to perceived injustice, as a moral emotion, this kind of epistemic injustice would have detrimental effects for people with BPD. If a person is consistently exposed to this kind of epistemic injustice, they risk losing faith in their own ability to pick out instances of injustice and act accordingly. Consequently, there is a viable risk that people with a BPD diagnosis are being wronged not just in their capacity as knowers but also as moral agents.